A prospective study of 1152 hospital autopsies: I. Inaccuracies in death certification
Article first published online: 16 JUN 2005
Copyright © 1981 The Pathological Society of Great Britain and Ireland
The Journal of Pathology
Volume 133, Issue 4, pages 273–283, April 1981
How to Cite
Cameron, H. M. and McGoogan, E. (1981), A prospective study of 1152 hospital autopsies: I. Inaccuracies in death certification. J. Pathol., 133: 273–283. doi: 10.1002/path.1711330402
- Issue published online: 16 JUN 2005
- Article first published online: 16 JUN 2005
- Manuscript Accepted: 25 JUL 1980
Comparison of certified clinical diagnoses with autopsy findings showed that, while the major cause of death was confirmed in 61 per cent. of cases, many diagnoses—both major and contributory—were wrong; many clinical diagnoses were either disproved or relegated to a less important role, and many autopsy findings had not apparently been anticipated. Accuracy was particularly poor in some clinical categories: notably cerebro-vascular disease and infections. In these, the diagnosis was more often wrong than right. Thus, death certificates are unreliable as a source of diagnostic data.
The clinician's confidence in his major diagnosis bore a fairly close relationship to the frequency of its confirmation. Nevertheless, even when certified as “fairly certain”, the major diagnosis was wrong in about one-quarter of these cases.
An attempt was made to assess the significance of incorrect diagnoses; one half of these might be clinically significant.
Diagnostic accuracy did not improve with the time spent in hospital, and it bore an inverse relationship to the patient's age.